Loading...
9706-076 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date ,✓� � 7f gnature of Contractor r i�Z' OWNER -BUILDER I hereby affirm under penalty of perjury=that I,am exempt from the Contractor's License Law for the following reason: �- ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, -am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). • . () I am exempt under Section' , B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided 'for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. ..v,;, A a-., � r w v^, ;-.f 3 t 1 t l� �i iJJ`�lJ VtitL\J,��'✓U (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions ofSection3700 of.the 'babor Code, I shall forthwith comply with those prov dons. t,•. Date: 4-')r,=1'7. Applicant !� f '.. ,�,tr�P ..�" w:/,nbr•Y+' :q -,y- Shy Warning: Failure to secure Workers Compensation coveragwis unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compe'°sation, damages as provided for in Section 3706 of the Labor Code, interest a`nnd attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application..`x 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees_. 2. Any permit issued as a result of this application becomes null and void if, Yi •� work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for ;inspection purposes,�� Signature (Owner/Agent) ate PERMIT # CONTROL # BUILDING PERMIT {)706-4176 BUILDING 5988 DATE !�( 9/4 VALUATION. i b> < \iil<, LOT TRACT J.R� 21 , BLK 3 DEs • c 1.JOB SITE ADDRESS .51-412 �..i`�,eUt, i 010.' APN 70.1 1.5, 4 OWNER CONTRACTOR //DESIIGNER ENGINEER ,!NIC WORLD ,C 41-R 9 3Orl�'DV1rFii.K ' 414K3 Rt:.311R6.2W.liLK PALM CA 92211 PALM CA 42211 (,7Cxl' %1.110t (''REE 46110 USE OF PERMIT, FWD in"T"0v 1,259,`t)`f rrR11C!r' 7 , tM�7iYa�..i.;.aM. Ctj 1`00 Sr° 460041 041 SY • wosl'it M�-s'.I`1"a3 C'��E"1"U"r'rIA0,4l` A,'rh .r. r a,c .1. +1'd3 ,) 1, +1fif,� '�.�� c ni a i3O.f.0 n;, x z. +\ saa i t Y. +tci 40dv a *,.P. I I" >r'C)23�'t't3f,��:'i'Ar�d�f !*'��i !t?t�flE?t�•��iS=L�(t $:`i�:',� ;�1.:�� t"�1�'�k, 4'F3; iiz�-1.1��•<�;34-,?11�', 4ub'?7 Q� S4�7,(W) �t4 t'fifb.il.�i �Z:� t�f�^'VHIf-�F�V"Fli%\J "b it�Tl-}l a97 vf - ra \.v {i\1 t\fiYi �WYlte xc�t.sryfi'�irrt.:x 1 r t ��g9an�»S�+.cei ia"v.SRt..� ;s J ,�..i"�.K�'•'fv<>%t0TaO, 0.,�v.:rato a:�ia•�•�°fc�`.}� �'.:+yFY ti�i���9:3'['it#.!� #tlf�J l�:t+ . 2'2S•f4ti0���fr:�P.��2 �•i,.�3 q � 3N 1i; (Ji�i `1 �:" t —NANM Pi.AT3t.WEirin'. $t,i7•t.R;• LESS ,"'U-PA110 i UI S 41250.00 �'�If'��i\Ei�H�G\. .t!'':�✓�vlAXR.;.fv A Q •`� I'Q.�''✓�«'T, 0.w .t'��.f VYt '�Kr�7.A'R.174 RECEIPT By 't if�'--�'' DATE FINALED INSPECTOR INSPEC710H RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts _ Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wali Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROV S POOLS - SPAS Steet., Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral/Pool Cover Sewer Connection ZEncapsulatlon Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final -42a 4WP Utility Notice (Perm) COMMENTS: Co��cc= Building Address •.E TLo iG0 Vq,M!Rl,�ir�l eC k /v7— P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 CityZip Tel. f Rei %fir-s�=� 91p�� 1�C-�? //o Contractor l b�F,4 i Address Zip State Lic. & Classif. I Arch., Engr., Designer Address city Lic. # Tel. City : ( Zip( State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirmthtptn licensed under provisioPs gJgx er 9 (commencing with Section 7000) of Division 3 o t B sina sand Professi ns•C a my license is in full forte and effect. SIGNATURE r DATE OWNER -BUILDER DE LARATION I hereby afA rm that I am exempt from the Contractor's License Law for the following reason:" (Se 7031.5, Business and Professions Code: Any city or county which requires a permitttooonstruct, atter, improve, demolish, or repair any structure, prior to'its issuance also requires the applicant for such permit to rile a signed statement that ne is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and the basis for thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). f : I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-buIder will have the burden of proving that he did not build or improve for the purpose of sale.) 1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a. contractor(s) licensed pursuant to the Contractor's License Law.) I'! I am exempt under Sec. B. 8 P.C. for this reason_ Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. ❑ Certified copy is hereby furnished. I CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of, hp work for which'ihis.�`.Pp r it>is�f3sled, I shall not employ any person m ny manner sovaslto�bec me subjegltrS,th"yrs' Compensation Laws oYCafi ",Own Cate-faYv Owner NOTICE TO APPLICANT: If,aff�r1dking this Certificate of Exemtrorr you should become subject to the Workers' Compensation provisions of the Labor .otle, you must forthwith comply with Such provisions o,tbis pdrmit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip l__ AP LIC .DING: TYPE'CONST. OCC. GRP. Numbere00 ,I Description CG% r;?,l BG� Ict Description AIR 9 RAtD Lggr REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTRA&_____�_ Issued by: Date --_Permit 1 Validated by: Juf� 0 997 Validation: tll1% ar WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION J* . Sq. Ft. No. Size Stories No. Dw. / Units NeWX Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. a 5(�. UJ Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTRA&_____�_ Issued by: Date --_Permit 1 Validated by: Juf� 0 997 Validation: tll1% ar WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION J* . Desert Sands Unified School District Notice: 82-879 Highway 111 ! ' Document Cannot Be Duplicated Indio, CA 92201619-775-3500 CERTIFICATE OF COMPLIANCE Date 9/29/97 No. 16127 Owner NameWorld Development, Inc. No. 51-412 City La Quinta Tract # Street Calle Iloilo Lot # Type of Development Single Family Residence Comments APN # 769-115-004 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 1299 No. of Units 1 r At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. ..�>a .—_It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.84 X 1,299 or $ 2,390.16 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By Cashier's CheckNalley Independent Bank Telephoiie ..862-1-101t,, Name on the check By Dr. Doris Wilson Superintendent r Fee collected /exempted by Ellen Patino Payment Received $2;3-9-0 16 4 h' y _ Check No. 143997 -Si�a� a �`✓ �b�C�C/ 40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date an which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to bllect them on the Districl('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or,city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting U i 777 M.1.l C.lJVn .7 rMn ;jIi. numumn TY OF RIVERSIDE HEALTH SERVICES AGENCY_1 _ Q0� ARTMENT OF ENVIRONMENTAL HEALTH MIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM LICA NIT: Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list. lion on-refundable filing fee is required when the application is submitted. Check must be made payable to the Coul of iv ide_ Appfi�t{at�f this applicgq shall remain valid for a period not to exceed one year from date of payment. j�" 238 14. 3al.UUi C LOG # 01 T/ OF L A ��t�� n/T�- CHN $214- ❑ Agent, Contractor, Contact Person Addressity State Zip Telephone Z;M .S;V0(4AM K4QF4 79 7 0 2i `'' v l v%A 6A9 0 //0/ Owner Address City State Zip Telephone Q City Zip Z Job Property Addre g ,Sl - q l �- rA [ I E _T[ 0/ L V I A 61u/�I/n� I0 U Lot Size Water Agency Use of Permit, PIP, SUP, PUP, etc. Legal Description _ cwn L' ' >< CA(", ttA VnuF/ f(� W T(Dt a71, Psv.2T ec u9 744ti l> ,r � ?, X CtJ /� T� j 7A1 ! Dwelling, M Sid Prep., etc. Signature o0A _ ��' - Date i. CIGMX IF REQUIRED Hing Tank Agreements Completed Certification of Existing S.D. System Required C01 ❑ WOCB Clearance Required ? (Attach For DOH -SAN -007, Santa Ana Region Only ❑ Soils Percolation Report Required ❑ Special Feasibility Boring Report Required Initials Date C/42 I Soils Percolation Bn Report by Soils Map Page Soil Type ❑ Detailed Contour Plot Plans Required (1 to 5 foot Interval) ❑ Grading Handout Provided ❑ Staff Specialist Lot Inspection Required ❑ Lot Inspection ❑ Date Lot Inspection Completed: Initials Remarks: ❑ Maintenance Booklet Provided ❑ Final Inspection by Department of Environmental Health is required. # Date gy Date Well Review Approved: Date: SIGNATURE Grading Plan Approved: Date: SIGNATURE Other: Well Drilling Permit # Trap Bed sq. ft. of This application is PPROVED/D N B FOR OFFICE USE ONLY abvv9,-%garding dhe a subsurface disposal system as Indicated on the ) aoompanied plot plan, using the requirements set forth In SECTION C above. A build - Ing permit is necessary for the Installation of the above -designed system. No construc- . Revenue code /42.3 Fee $ I tion is permitted in the required reserved 100% expansion area. (1) optic Tank must be 4"minimum from any wells. >/ /U/ 40ACh./KK # ?i v v f (2) Leach lines must be 100' minimum from any wells, inciudi expansion area. Date - ..7 L 27 initial TAI ❑ (3) Sewer lines must be 50' minimum from any wells.t' E��T /vv 3 ! I w CO )Seepage pitspu__st be 150' minimum from any wells, including expansion area. /G, Signature of Health Official Date 00H -SAN 122 (Rev 9193) No of Systems 1 Type f system(s) ❑ olding Tank Cil New ❑ Existing ❑ Replacement ❑Addition No. Dwelling Units( t 1 Bedrooms, 4Wwo•Wnilc 116MA d647W � (1) Septic Tank / 0013a).It Soil Rate /^01 Gf Greas Proposed Bottom Tested Dep Sq. Ft. om Area otal Linear Sidewall Allowance f . sq. h. running h. Install ft. long h. wide with Inlet Tested Depth Q NA min. Inches r Blow drainlines or Well Review Approved: Date: SIGNATURE Grading Plan Approved: Date: SIGNATURE Other: Well Drilling Permit # Trap Bed sq. ft. of This application is PPROVED/D N B FOR OFFICE USE ONLY abvv9,-%garding dhe a subsurface disposal system as Indicated on the ) aoompanied plot plan, using the requirements set forth In SECTION C above. A build - Ing permit is necessary for the Installation of the above -designed system. No construc- . Revenue code /42.3 Fee $ I tion is permitted in the required reserved 100% expansion area. (1) optic Tank must be 4"minimum from any wells. >/ /U/ 40ACh./KK # ?i v v f (2) Leach lines must be 100' minimum from any wells, inciudi expansion area. Date - ..7 L 27 initial TAI ❑ (3) Sewer lines must be 50' minimum from any wells.t' E��T /vv 3 ! I w CO )Seepage pitspu__st be 150' minimum from any wells, including expansion area. /G, Signature of Health Official Date 00H -SAN 122 (Rev 9193) Proposed Bottom Tested Dep U Z Leach ines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum f Total Depth Allowable Applicable + �O f Depth Overburden r �' l7 6' TO~ T� 40 . W U NIA Well Review Approved: Date: SIGNATURE Grading Plan Approved: Date: SIGNATURE Other: Well Drilling Permit # Trap Bed sq. ft. of This application is PPROVED/D N B FOR OFFICE USE ONLY abvv9,-%garding dhe a subsurface disposal system as Indicated on the ) aoompanied plot plan, using the requirements set forth In SECTION C above. A build - Ing permit is necessary for the Installation of the above -designed system. No construc- . Revenue code /42.3 Fee $ I tion is permitted in the required reserved 100% expansion area. (1) optic Tank must be 4"minimum from any wells. >/ /U/ 40ACh./KK # ?i v v f (2) Leach lines must be 100' minimum from any wells, inciudi expansion area. Date - ..7 L 27 initial TAI ❑ (3) Sewer lines must be 50' minimum from any wells.t' E��T /vv 3 ! I w CO )Seepage pitspu__st be 150' minimum from any wells, including expansion area. /G, Signature of Health Official Date 00H -SAN 122 (Rev 9193) i 1 SEP.'-24'97(WED) 12:13 � I FIDELITY NAT TITLE TEL: 1-619-779-0394 nn� F7 Iii 333689 REC'J1�, T� RcQCESTF < FIDELITY ii,a., ,.AL I'RECEIVED FOR RECORD 1 RECORDING REQUESTED BY: AT 2:00 O'CLOCK a YBARRONDO & PATIERSON � ��SEP 12199, 3 WHEN RECORDED, MAIL TO: 4 1 YBARRONDO & PATTI-ERSON 11 112 13 14 I 15 X16 FVA 18 19 20 ,1 21 22 23 24 25 26 27 28 Atomeys at Law Post Office Box 3867; Hemet, California 92546 '7u9 - -404 -~I GRANT DEED OF EXECUTOR DT T� (p . O S. CidUU1U 1 RAY WRIGHT, as Executor of Ow' Will of LEON D. FINLEY, by order of the Superior Court of the State of California, County of Riverside, made in the matter of the Estate of LEAN D. FINLEY on August 4, 1997, confirming the We of real property and directing the ^Ymtion of a conveyance, hereby grants to WORLDOMDEVELOPMENT, INC., A CALIFORNIA CORPORATION, all right, title, interest, and estate of the decedent at the time of death and all right, title and interest that the estate may have subsequently acquired in the real property situate in the City of La Quinta, County of Riverside, State of California, described as follows: Lot 21,. in Block 3 of Unit 2 of the Desert Club Tract, as shown by Map on file in Book 20, Page 6 of Maps, in the Office of the Riverside County Recorder. DATED: July 14, 1997 . MAIL TA2J SLUENOTS TOr World Development,; Inc. nFF-n 0 YWRIkW, Execu of the Estate of D. INLEY, aW JAY FINLEY .0 SEP. =24' 91(WED) • � 'I. 12:13 FIDELITY NAT TITLE TEL:1-619-119-0394 hLIFORNIA •LL•PURPOSE ACKNawumAMEt w "0 W i State of CALIFORNIA 1 ' County of ltl3=stnv ;11 On i= 14- 12,E Wore me, ( --- OATS oFrtlta . 'Ok UW- WYWAY 1rUU= CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT .` ❑ INDIVIDUAL :� ❑ CORPORATE OFFICER gftA]QT REED OF F3ECUT0 TTTLE OR TYPE OF DOCUMENT i' SII �!� ❑ PARTNERIS) ❑ utr-M ❑ GENERAL -2— including t:hi, page ❑ ATroANEY-w-FACT NUMBER OF PAGES � ❑ TRUSTEE(5) 't Q GUARDIMNCONSERVATOR OTHER: EXECUTOR JULY 14, 1997 ,1 DATE OF DOCUME14T �i $041E t IS REp'MENTINQ: twatoRPgRKM10*tWdVt1tM NONE •, ESTATE OF LEON 1). FINLEY • _ _ SIGNER(S) OTHER THAN NAMED ABOVE P. 002 31 3 5 8 9. !� 1 019q M ATIOW NOTARY ASSOCIATM • f X PAmm 1 Ave. 00 Oa 1164 • C4aq* Pr%. CA113M? 164 W pm--- - - im personally appeared MY WR M, EXECUTOR OP TBE ESTATL' OF LEON D. FINLEY , SM91 11f NrOMM R known to me -'OR - ❑ proved to me on the basis of satisfactory evidence ;2 .�1 personalty to be the person(s) whose neme(s) Is/are subscribed to the within Instrument and ac- knoWedged to me that he/she/they executed the same In his/her/their authorized capacity(ies). and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ,JOYCE W. QUlNBY ;• � t (MYMRMJR/tC's n ,�U:�.� � ���t�umr � WITNESS my hand and official seal, j OPTIONAL y T 0jo OW data WOW is not M QOMd-by tar.. O may p n vatuebfe to persons rntyRlp on tea dOrumerd.nd could prevent frau*&M realtactomM of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT .` ❑ INDIVIDUAL :� ❑ CORPORATE OFFICER gftA]QT REED OF F3ECUT0 TTTLE OR TYPE OF DOCUMENT i' SII �!� ❑ PARTNERIS) ❑ utr-M ❑ GENERAL -2— including t:hi, page ❑ ATroANEY-w-FACT NUMBER OF PAGES � ❑ TRUSTEE(5) 't Q GUARDIMNCONSERVATOR OTHER: EXECUTOR JULY 14, 1997 ,1 DATE OF DOCUME14T �i $041E t IS REp'MENTINQ: twatoRPgRKM10*tWdVt1tM NONE •, ESTATE OF LEON 1). FINLEY • _ _ SIGNER(S) OTHER THAN NAMED ABOVE P. 002 31 3 5 8 9. !� 1 019q M ATIOW NOTARY ASSOCIATM • f X PAmm 1 Ave. 00 Oa 1164 • C4aq* Pr%. CA113M? 164 W pm--- - - im 'Yr` Copj low rri C' lu FL t JA CL 4 �` .'. ',.; ;til ,�. � � .a �•�.� � � _ 1 :�-. . t -.. R f